Foot & Ankle

Question 1

Causes of ankle OA

Answer 1

idiopathic

consequence of previous injury

Question 2

What movement of the ankle may result in anterior ankle damage and osteophyte formation

Answer 2

Repeated ankle dorsiflexion

Question 3

Tx of anterior ankle osteophytes

Answer 3

Cheilectomy - removal of the anterior osteophytes

Question 4

Surgical options for advanced OA

Answer 4

Arthrodesis

Ankle replacement

Question 5

Advantage of ankle replacements over arthrodesis

Answer 5

Better functional outcome due to some preservation of motion

Question 6

Disadvantage of ankle replacements compared to arthrodesis

Answer 6

Ankle replacements put high stress and shearing force across the small ankle bones, resulting in difficulties in fixation and early loosening.

Question 7

What patient group should ankle replacements be reserved for and why

Answer 7

Elderly - once failure occurs the ankle will require fusion which produces a shortened limb

Question 8

Advantage of arthrodesis over ankle replacement

Answer 8

re-operation rates are much lower

Question 9

What is Hallux Valgus

Answer 9

medial deviation of the 1st metatarsal and lateral deviation of the toe itself

Question 10

In what conditions is Hallux Valgus more common?

Answer 10

Inflammatory arthropathies

Question 11

Presentation of hallux valgus

Answer 11

rubbing of foot on shoes - bursitis over the 1st metatarsal head (bunion)

Question 12

What is transfer metatarsalgia

Answer 12

Seen in hallux valgus -
normally all the power goes through the large toe.
The function of the great toe is lost, so the power now goes through the other toes

Question 13

Tx of hallux valgus

Answer 13

Non-operative:
Shoe accommodations
Spacer in 1st web space to stop rubbing

Operative:
Osteotomies to realign the bones
Soft tissue procedures to correct laxity or tightness of tissues

Question 14

What is Hallux rigidus

Answer 14

OA of the first MTPj

Question 15

Tx hallux rigidus

Answer 15

Arthrodesis

Question 16

What do plantar interdigital nerves arise from

Answer 16

medial and lateral plantar nerves (which have arisen from tibial nerve)

Question 17

What is Morton’s neuroma

Answer 17

irritated interdigital nerves that have become inflamed and swollen due to repeated trauma, and have formed a neuroma

Question 18

Presentation of morton’s neuroma

Answer 18

burning pain and tingling radiating into the affected toes

forefoot pain (metatarsalgia)

Question 19

What foot interspace nerve is most commonly affected in Morton’s neuroma

Answer 19

3rd interspace nerve

then 2nd

Question 20

Ix for Morton’s Neuroma

Answer 20

Mulder’s click test - squeezing the forefoot reproduces symptoms or produces a characteristic click

USS - demonstrates swollen nerve

Question 21

Tx Morton’s neuroma

Answer 21

Non-op:
insoles
Steroid and analgesia injections

Op:
Excision of neuroma

Question 22

Most common MTP for stress #

Answer 22

2nd metatarsal

Question 23

Tx metatarsal stress #

Answer 23

rest and 6-12 weeks in rigid soled boot

Question 24

Causes of Achilles Tendonitis

Answer 24

Repetitive strain (From sports)
Quinolone Abx
Inflammatory arthropathies

Question 25

Tx of Achilles Tendinitis

Answer 25

Rest Physio Heel raise in shoe to offload tendon Splint/boot use

Question 26

Why should steroids not be used for Tx of achilles tendonitis

Answer 26

Risk of rupturing the tendon

Question 27

Causes of Achilles Tendon rupture

Answer 27

degenerative changes within in the tendon recent tendonitis

Question 28

Test for confirming Achilles Tendon rupture

Answer 28

Simmonds test no plantar flexion of the foot seen when squeezing the calf

Question 29

Presentation of Achilles Tendon rupture

Answer 29

unable to weight bear sudden pain palpable gap in the tendon

Question 30

Tx of Achilles Tendon rupture

Answer 30

Non-op: series of casts in the equinous position - the ankle plantarflexed with toes pointing down, as this closes the gap in the torn tendon Operative: suture repair of tendon, fixed with casts for 8 weeks

Question 31

Origin of the plantar aponeurosis

Answer 31

distal plantar aspect of the calcaneal tuberosity

Question 32

What is plantar fasciitis

Answer 32

inflammation of the thick supporting arch tissue on the sole of the foot

Question 33

Causes of plantar fasciitis

Answer 33

diabetes obesity poor cushioning in shoes repetitive stress (sports)

Question 34

Presentation of plantar fasciitis

Answer 34

start up pain after rest localised tenderness on palpation of origin of plantar aponeurosis

Question 35

Tx of plantar fasciitis

Answer 35

rest NSAIDs stretching exercises gel filled heel pad

Question 36

how long can symptoms of plantar fasciitis take to resolve

Answer 36

up to 2 years

Question 37

what is pes planus

Answer 37

adult flat foot - medial arch does not develop

Question 38

causes of pes planus

Answer 38

developmental - ligament laxity acquired - tibialis posterior tendon stretch or rupture, RA, diabetes with Charcot foot

Question 39

insertion of the tibialis posterior tendon

Answer 39

medial navicular

Question 40

function of the tibialis posterior tendon

Answer 40

support the medial arch of the foot plantarflexes the foot inverts the foot

Question 41

stress of the tibialis posterior tendon leads too..?

Answer 41

tendonitis, elongation and eventual rupture

Question 42

Tx of tibialis posterior tendonitis?

Answer 42

splint of medial arch - aim is to avoid rupture if this fails - surgical decompression + tenosynovectomy

Question 43

Symptoms of tibialis posterior tendon elongation

Answer 43

Loss of medial arch valgus of the heel ("too many toes" showing on lateral border when looking from behind) flattening of the medial arch of the foot

Question 44

Potential consequence of tibialis posterior tendon elongation (with regards to the foot)

Answer 44

degenerative OA of the hindfoot and midfoot

Question 45

Tx of tibialis posterior tendon elongation a) without OA present b) with OA present

Answer 45

a) tendon transfer | b) arthrodesis

Question 46

Most common group to have tibialis posterior tendon dysfunction

Answer 46

Obese middle aged females hypertensives diabetes

Question 47

What is pes cavus

Answer 47

Abnormally high arch of the foot

Question 48

Causes of pes cavus

Answer 48

Idiopathic ``` Neuromuscular conditions - hereditary sensory and motor neuropathy cerebral palsy polio spina bifida occulta ```

Question 49

What other foot abnormality commonly accompanies pes cavus

Answer 49

claw toes

Question 50

Tx of pes cavus

Answer 50

If supple - Soft tissue releases tendon transfer If rigid - Calcaneal osteotomy If severe - arthrodesis

Question 51

Cause of claw toes and hammer toes

Answer 51

acquired imbalance between the flexor and extensor tendons

Question 52

what are claw toes

Answer 52

hyperextension at the MTPj with hyperflexion at the PIPj and DIPj

Question 53

what are hammer toes

Answer 53

hyperextension at the MTPj with hyperflexion at the PIPj and hyperextension at the DIPj

Question 54

Tx of claw and hammer toes

Answer 54

Non-operative: toe sleeves corn plasters ``` Operative: Tenotomy (division of overactive tendon) Tendon transfer Arthrodesis ?toe amputation ```